title: Technical aspects and outcomes of tracheobronchoplasty for severe tracheobronchomalacia.
abstract: BACKGROUND
  Tracheobronchomalacia is an underrecognized cause of dyspnea, recurrent respiratory infections, and cough. Surgical stabilization with posterior membranous tracheobronchoplasty has been shown to be effective in selected patients with severe disease. This study examines the technical details and complications of this operation.
  
  
  METHODS
  A prospectively maintained database of tracheobronchomalacia patients was queried retrospectively to review all consecutive tracheobronchoplasties performed from October 2002 to June 2009. Posterior splinting was performed with polypropylene mesh. Patient demographics, surgical outcomes, and operative data were reviewed.
  
  
  RESULTS
  Sixty-three patients underwent surgical correction of tracheal and bilateral bronchial malacia. Twenty-three patients had chronic obstructive pulmonary disease, 18 had asthma, 5 had Mounier-Kuhn syndrome, and 4 had interstitial lung disease. Seven patients had a previous tracheotomy. Operative time was 373 ± 93 minutes. Median length of stay was 8 days (range, 4 to 92 days), of which 3 days (range, 0 to 91 days) were in intensive care. Seventy-five percent of patients were discharged home (28% with visiting nurse follow-up), and 25% went to a rehabilitation facility. Two patients (3.2%) died postoperatively-1 of worsening usual interstitial pneumonia, and the other of massive pulmonary embolism. Complications included a new respiratory infection in 14 patients, pulmonary embolism in 2, and atrial fibrillation in 6. Six patients required reintubation, and 9 received a postoperative tracheotomy; 47 patients required postoperative aspiration bronchoscopy.
  
  
  CONCLUSIONS
  In experienced hands, tracheobronchoplasty can be performed with a very low mortality rate and an acceptable perioperative complications rate in patients with significant pulmonary comorbidity. Intervention for postoperative respiratory morbidity is often necessary.
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Department of Surgery, Harvard Medical School, Boston, Massachusetts 02215, USA. sgangadh@bidmc.harvard.edu
authors.forename: Sidhu P
authors.initials: SP
authors.lastname: Gangadharan
authors.forename: Charles T
authors.initials: CT
authors.lastname: Bakhos
authors.forename: Adnan
authors.initials: A
authors.lastname: Majid
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kent
authors.forename: Gaetane
authors.initials: G
authors.lastname: Michaud
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
authors.forename: Simon K
authors.initials: SK
authors.lastname: Ashiku
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D015996:Survival Rate; D013536:Suture Techniques; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055089:Tracheobronchomalacia / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome